The tympanic membrane displacement analyser for monitoring intracranial pressure in children

Samson Gwer; Victoria Sheward; Anthony Birch; Robert Marchbanks; Richard Idro; Charles R. Newton; Fenella J. Kirkham; Jean-Pierre Lin; Ming Lim

doi:10.1007/s00381-013-2036-5

The tympanic membrane displacement analyser for monitoring intracranial pressure in children

Samson Gwer^*, Victoria Sheward, Anthony Birch, Robert Marchbanks, Richard Idro, Charles R. Newton, Fenella J. Kirkham, Jean-Pierre Lin, Ming Lim

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

48 Citations (Scopus)

Abstract

Purpose
Raised intracranial pressure (ICP) is a potentially treatable cause of morbidity and mortality but tools for monitoring are invasive. We sought to investigate the utility of the tympanic membrane displacement (TMD) analyser for non-invasive measurement of ICP in children.

Methods
We made TMD observations on normal and acutely comatose children presenting to Kilifi District Hospital (KDH) at the rural coast of Kenya and on children on follow-up for idiopathic intracranial hypertension at Evelina Children's Hospital (ECH), in London, UK.

Results
We recruited 63 patients (median age 3.3 (inter-quartile range (IQR) 2.0-4.3) years) at KDH and 14 children (median age 10 (IQR 5-11) years) at ECH. We observed significantly higher (more negative) TMD measurements in KDH children presenting with coma compared to normal children seen at the hospital's outpatient department, in both semi-recumbent [mean -61.3 (95 % confidence interval (95 % CI) -93.5 to 29.1) nl versus mean -7.1 (95 % CI -54.0 to 68.3) nl, respectively; P = 0.03] and recumbent postures [mean -61.4 (95 % CI -93.4 to -29.3) nl, n = 59) versus mean -25.9 (95 % CI -71.4 to 123.2) nl, respectively; P = 0.03]. We also observed higher TMD measurements in ECH children with raised ICP measurements, as indicated by lumbar puncture manometry, compared to those with normal ICP, in both semi-recumbent [mean -259.3 (95 % CI -363.8 to -154.8) nl versus mean 26.7 (95 % CI -52.3 to 105.7) nl, respectively; P <0.01] and recumbent postures [mean -137.5 (95 % CI -260.6 to -14.4) nl versus mean 96.6 (95 % CI 6.5 to 186.6) nl, respectively; P <0.01].

Conclusions
The TMD analyser has a potential utility in monitoring ICP in a variety of clinical circumstances.

Original language	English
Pages (from-to)	927-933
Number of pages	7
Journal	Childs Nervous System
Volume	29
Issue number	6
DOIs	https://doi.org/10.1007/s00381-013-2036-5
Publication status	Published - Jun 2013

Keywords

Intracranial pressure
Idiopathic intracranial hypertension
Coma
Child
FLUID PRESSURE
HYPERTENSION
MALARIA
MANAGEMENT
DIAGNOSIS
INJURY

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00381-013-2036-5

Cite this

@article{db3461cf6c60422abe2b02a946e13bd0,

title = "The tympanic membrane displacement analyser for monitoring intracranial pressure in children",

abstract = "Purpose Raised intracranial pressure (ICP) is a potentially treatable cause of morbidity and mortality but tools for monitoring are invasive. We sought to investigate the utility of the tympanic membrane displacement (TMD) analyser for non-invasive measurement of ICP in children. Methods We made TMD observations on normal and acutely comatose children presenting to Kilifi District Hospital (KDH) at the rural coast of Kenya and on children on follow-up for idiopathic intracranial hypertension at Evelina Children's Hospital (ECH), in London, UK. Results We recruited 63 patients (median age 3.3 (inter-quartile range (IQR) 2.0-4.3) years) at KDH and 14 children (median age 10 (IQR 5-11) years) at ECH. We observed significantly higher (more negative) TMD measurements in KDH children presenting with coma compared to normal children seen at the hospital's outpatient department, in both semi-recumbent [mean -61.3 (95 % confidence interval (95 % CI) -93.5 to 29.1) nl versus mean -7.1 (95 % CI -54.0 to 68.3) nl, respectively; P = 0.03] and recumbent postures [mean -61.4 (95 % CI -93.4 to -29.3) nl, n = 59) versus mean -25.9 (95 % CI -71.4 to 123.2) nl, respectively; P = 0.03]. We also observed higher TMD measurements in ECH children with raised ICP measurements, as indicated by lumbar puncture manometry, compared to those with normal ICP, in both semi-recumbent [mean -259.3 (95 % CI -363.8 to -154.8) nl versus mean 26.7 (95 % CI -52.3 to 105.7) nl, respectively; P <0.01] and recumbent postures [mean -137.5 (95 % CI -260.6 to -14.4) nl versus mean 96.6 (95 % CI 6.5 to 186.6) nl, respectively; P <0.01]. Conclusions The TMD analyser has a potential utility in monitoring ICP in a variety of clinical circumstances.",

keywords = "Intracranial pressure, Idiopathic intracranial hypertension, Coma, Child, FLUID PRESSURE, HYPERTENSION, MALARIA, MANAGEMENT, DIAGNOSIS, INJURY",

author = "Samson Gwer and Victoria Sheward and Anthony Birch and Robert Marchbanks and Richard Idro and Newton, {Charles R.} and Kirkham, {Fenella J.} and Jean-Pierre Lin and Ming Lim",

year = "2013",

month = jun,

doi = "10.1007/s00381-013-2036-5",

language = "English",

volume = "29",

pages = "927--933",

journal = "Childs Nervous System",

issn = "0256-7040",

publisher = "Springer Verlag",

number = "6",

}

TY - JOUR

T1 - The tympanic membrane displacement analyser for monitoring intracranial pressure in children

AU - Gwer, Samson

AU - Sheward, Victoria

AU - Birch, Anthony

AU - Marchbanks, Robert

AU - Idro, Richard

AU - Newton, Charles R.

AU - Kirkham, Fenella J.

AU - Lin, Jean-Pierre

AU - Lim, Ming

PY - 2013/6

Y1 - 2013/6

N2 - Purpose Raised intracranial pressure (ICP) is a potentially treatable cause of morbidity and mortality but tools for monitoring are invasive. We sought to investigate the utility of the tympanic membrane displacement (TMD) analyser for non-invasive measurement of ICP in children. Methods We made TMD observations on normal and acutely comatose children presenting to Kilifi District Hospital (KDH) at the rural coast of Kenya and on children on follow-up for idiopathic intracranial hypertension at Evelina Children's Hospital (ECH), in London, UK. Results We recruited 63 patients (median age 3.3 (inter-quartile range (IQR) 2.0-4.3) years) at KDH and 14 children (median age 10 (IQR 5-11) years) at ECH. We observed significantly higher (more negative) TMD measurements in KDH children presenting with coma compared to normal children seen at the hospital's outpatient department, in both semi-recumbent [mean -61.3 (95 % confidence interval (95 % CI) -93.5 to 29.1) nl versus mean -7.1 (95 % CI -54.0 to 68.3) nl, respectively; P = 0.03] and recumbent postures [mean -61.4 (95 % CI -93.4 to -29.3) nl, n = 59) versus mean -25.9 (95 % CI -71.4 to 123.2) nl, respectively; P = 0.03]. We also observed higher TMD measurements in ECH children with raised ICP measurements, as indicated by lumbar puncture manometry, compared to those with normal ICP, in both semi-recumbent [mean -259.3 (95 % CI -363.8 to -154.8) nl versus mean 26.7 (95 % CI -52.3 to 105.7) nl, respectively; P <0.01] and recumbent postures [mean -137.5 (95 % CI -260.6 to -14.4) nl versus mean 96.6 (95 % CI 6.5 to 186.6) nl, respectively; P <0.01]. Conclusions The TMD analyser has a potential utility in monitoring ICP in a variety of clinical circumstances.

AB - Purpose Raised intracranial pressure (ICP) is a potentially treatable cause of morbidity and mortality but tools for monitoring are invasive. We sought to investigate the utility of the tympanic membrane displacement (TMD) analyser for non-invasive measurement of ICP in children. Methods We made TMD observations on normal and acutely comatose children presenting to Kilifi District Hospital (KDH) at the rural coast of Kenya and on children on follow-up for idiopathic intracranial hypertension at Evelina Children's Hospital (ECH), in London, UK. Results We recruited 63 patients (median age 3.3 (inter-quartile range (IQR) 2.0-4.3) years) at KDH and 14 children (median age 10 (IQR 5-11) years) at ECH. We observed significantly higher (more negative) TMD measurements in KDH children presenting with coma compared to normal children seen at the hospital's outpatient department, in both semi-recumbent [mean -61.3 (95 % confidence interval (95 % CI) -93.5 to 29.1) nl versus mean -7.1 (95 % CI -54.0 to 68.3) nl, respectively; P = 0.03] and recumbent postures [mean -61.4 (95 % CI -93.4 to -29.3) nl, n = 59) versus mean -25.9 (95 % CI -71.4 to 123.2) nl, respectively; P = 0.03]. We also observed higher TMD measurements in ECH children with raised ICP measurements, as indicated by lumbar puncture manometry, compared to those with normal ICP, in both semi-recumbent [mean -259.3 (95 % CI -363.8 to -154.8) nl versus mean 26.7 (95 % CI -52.3 to 105.7) nl, respectively; P <0.01] and recumbent postures [mean -137.5 (95 % CI -260.6 to -14.4) nl versus mean 96.6 (95 % CI 6.5 to 186.6) nl, respectively; P <0.01]. Conclusions The TMD analyser has a potential utility in monitoring ICP in a variety of clinical circumstances.

KW - Intracranial pressure

KW - Idiopathic intracranial hypertension

KW - Coma

KW - Child

KW - FLUID PRESSURE

KW - HYPERTENSION

KW - MALARIA

KW - MANAGEMENT

KW - DIAGNOSIS

KW - INJURY

U2 - 10.1007/s00381-013-2036-5

DO - 10.1007/s00381-013-2036-5

M3 - Article

SN - 0256-7040

VL - 29

SP - 927

EP - 933

JO - Childs Nervous System

JF - Childs Nervous System

IS - 6

ER -

The tympanic membrane displacement analyser for monitoring intracranial pressure in children

Abstract

Keywords

UN SDGs

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